Methods of Contraception

There are many effective birth control options available these days. Here we shall discuss few of them in details:

1. IUDs-IntraUterine Devices: IUDs are small intrauterine devices that are impregnated with hormones. They are commonly known as copper T or copper iud. It is a T shaped device that is inserted into the uterine cavity. The mode of action of the IUD is that it elutes hormones or copper that make the cervical mucous thick thus preventing fertilization. It also prevents ovulation and stops uterine wall build up. The most effective kind of IUD is the levonorgestrel (progesterone) releasing intrauterine device. It provides contraception for a period of five years. An iud is recommended for those women who have already had their first child. Common iud side effects include spotting and cramping pain the abdomen. The efficacy rate is known to be 99%.
2. Barrier Methods: Barrier methods of contraception are those devices that physically prevent the entry of the sperm into the uterine cavity and thereby preventing fertilization and pregnancy. These include male and female condoms, cervical caps and diaphragms and contraceptive sponges with spermicide. This is the commonest over the counter birth control option.Condoms are the most popular and effective barrier method. They are commonly made out of latex, are easy to use and inexpensive. This method involves putting on a condom over the erect penis of the male. This prevents the entry of the sperms into the cervix of the female partner and thereby prevents the female from conceiving. Another very important use of the condom is that it prevents the transmission of sexually transmitted disease in individuals having unprotected sex or having illicit sexual relations. The commonest mode of transmission of HIV/AIDS and other STDs like syphilis and gonorrhea is via sexual intercourse. There is a small failure rate associated with condoms due to improper usage or tearing of the condom but it accounts for a very small percentage of cases.
3. Hormonal Methods and Contraceptive Pills: There are two types of contraceptive pills. One is the estrogen progesterone pill and the other is the only progesterone pill also called as mini pill. Both these provide contraception by preventing ovulation and thickening up the cerival mucus. In turn both these will prevent the egg and sperm from fertilizing and thereby the chances of a pregnancy become zero.The pill is often associated with side effects like breast tenderness, headache and nausea due to the effect of hormone estrogen.Other hormonal methods are contraceptive implants under the skin, birth control patch and injections. The commonest injection (birth control shot) used is depo provera which provides contraception for a period of one year.
4. Sterilization Surgery: Surgical sterilization is method of providing permanent contraception. It is available as vasectomy or male birth control and tubal ligation in females. In males, the vas deference that carries the sperms is ligated and in females the fallopian tubes that transport the egg to the uterine cavity is ligated. In both the cases, there is a creation of a mechanical block due to which the egg and sperm cannot meet and thereby the chance of a pregnancy is ruled out. This option is suitable for those females who already have two or more children above the age of 5. Although it is a permanent surgical procedure, if needed surgical re-canalization can be done. This mode of birth control does not provide any protection against sexually transmitted diseases.
5. Emergency Contraception: Emergency contraceptive pills are used mostly after an episode of unprotected sex with a hope of preventing a pregnancy. They are also referred to as the morning after pill. The mode of action of these pills is to prevent ovulation and fertilization. They do not provide any protection against sexually transmitted diseases. The various options include high dose contraceptive pills, ulipristal which has been found to be more effective in obese subjects, levonogestrel, mifeprestone and IUDs.
6. Breastfeeding : A breastfeeding mother usually has lactational amenorrhoea for the first six months. This period is known to be a natural contraceptive. The two pre-conditions here are absence of periods and exclusive breast feeding of the baby. This is not an absolute contraceptive period and in many females, fertility returns early and they can conceive even when they are breast feeding.

Advantages of Using Birth Control

Birth control has multiple benefits. It provides freedom to the couple to have a normal sex life without the fear of pregnancy. There are a multitude of options available and the couple can choose what suits them the best. Contraception helps to space the children adequately and also provide the mother time to recuperate from the first pregnancy. Children born very close in age gap, make it very difficult for the mother as her body barely gets any time to recover from the strain of the first pregnancy. This was one major reason behind high infant mortality rates in some Asian countries. Barrier methods provide protection against sexually transmitted diseases. The awareness of STDs in today’s youth is very important as it can prevent unwanted teen pregnancies and transmission of HIV/AIDS.

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During pregnancy, the baby’s umbilical cord is attached to the placenta which is implanted in the wall of the mother’s uterus. The baby derives all the nutrition from the placenta till the time he is born. Immediately after birth, during the second stage of labor, the baby is delivered and the umbilical cord is clamped with two clips and cut. The baby is now a separate entity. During the third stage of labor, the placenta is delivered by spontaneous contraction of the uterus. The blood within the umbilical cord is called cord blood. This umbilical cord blood contains stem cells which are used to treat various disorders as they can grow into organs, blood vessels and tissues. Cord blood banking is the preservation of the baby’s cord blood and isolation of the stem cells which have lifesaving properties for future use. They are preserved by cord blood banks which are similar in operation to a blood bank.

How is Cord Blood Collected?

Cord blood is to be collected immediately after birth. It is a very quick and painless procedure and takes only a few minutes. As soon as the baby is born, the newborn umbilical cord is clamped and cut by the doctor. If there is a delay for more than few minutes then the blood in the cord gets clot and so, it has to be collected fast. A needle is inserted into the umbilical vein of the cord attached to the placenta. The blood drains into a collection bag. Approximately 1 to 5 ounces are collected and the total time taken is about 10 minutes. The blood is then immediately sent to the cord blood bank (cell bank) where detailed testing takes place. The blood is then processed and stored in very low temperature. This process of freezing is called cryopreservation. Recent advances in the medical science are now trying to freeze a part of the umbilical cord itself to isolate the stem cells and study their use in treating diseases. Even placenta banking has gained importance in the recent times and research is underway to know about its contribution in treating various diseases.

Benefits of Stem Cells (Cord Blood Banking)

Stem cells are abundantly available and are found in the bone marrow, embryos, fetal tissue, blood and muscles of the body. Every part of the body has some stem cells but they are not sufficient in quantity that they can be harvested for medical or therapeutic use. Cord blood is a very rich source of stem cells which can be easily isolated. They are important structural elements of the immune system. They have the potential to develop into different types of cells so they can be used to regenerate damaged cells and tissues in cases of pathological conditions. This is one of the main reasons why stem cell preservation has gained a lot of importance in the recent times.

The use of stem cells is tested very well in leukemia. The only line of treatment known is chemotherapy. The disease goes into remission once the diseased cells are destroyed by the chemotherapy. In severe cases or those not responding to treatment, the patients are advised for stem cell transplantation where pleuripotent stem cells are inserted into the body which can stimulate new blood cells and improve the patient’s recovery rates. The stem cells that are found in the peripheral blood are mature whereas the ones in the cord blood are immature so they do not throw up a very strong defense reaction and hence are easier to transplant in patients. The body has a tendency to react or reject any foreign substance entering the body. In cord cells, the rate of rejection is also low.

Diseases That can be Treated with Cord Blood

Cord blood can now be used to treat a number of disorders. Research shows that using the patient’s own cells gives the best results except in some genetic disorders where the defect might be present in the genes. In such cases donor cells may be required.

The diseases that can be treated with cord blood are:

1. Blood disorders
2. Cancer
3. Leukemia
4. Aplastic anemia
5. Hodgkin’s and Non Hodgkin’s lymphoma
6. Thalassemia
7. Sickle cell anemia
8. Rare metabolic disorders of infants

The most recent study and research is aimed at trying to use the cord blood cells in treating disorders like hydrocephalus, type 1 diabetes (juvenile diabetes) and congenital heart defects. If these trials are successful, cord blood banking may become a mandate for each baby. Currently in many countries it is widely used but not compulsory due to the high cost involved. Stem cell banking cost in India is currently between 20 to 40 thousand rupees.

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Hemorrhoids are the swollen veins located in the lowermost part of the rectum. It is a commonly seen problem these days because of the changing lifestyle. The veins get swollen and may begin to bulge out of the anus. These swollen veins are called piles (hemorrhoids). They can be internal or external. They are the commonest cause of rectal hemorrhage. It is not a serious disorder but if not treated in time, can get severe as the constant bleeding may lead to anemia.

There are two types of hemorrhoids – Internal and External. Internal hemorrhoids are the ones which develop inside the rectum. They do not cause any pain and the only way to diagnose them is if the patient complains of rectal bleeding. External hemorrhoid form near the anal opening and are painful as there is more pain sensing nerves outside. They are diagnosed by symptoms of pain and bleeding from the rectum. If the veins swell up a lot, they may prolapse into the anus and may bulge while passing stool giving rise to bleeding hemorrhoids. These are diagnosed by examination and are seen as pinkish red bumps around the anal sphincter.

Causes of Hemorrhoids

The most common cause of hemorrhoids is mechanical pressure. The excessive pressure in the rectum causes the veins to swell up. The pressure could be due to many reasons.

• Straining or lifting very heavy weights (hard physical labor)
• Pushing during a bowel movement
• Constipation
• Passing a large, hard stool.
• Pregnancy – the growing uterus causes a pressure on the rectum and leads to swelling of the veins inside the rectum.

There are some risk factors which are known to be associated with hemorrhoids. They are sedentary lifestyle, obesity, patients with chronic diarrhea, chronic coughing or sneezing which also increases the pressure in the rectum.

Symptoms of Hemorrhoids

The symptoms of hemorrhoids is same as the symptoms of piles. However, you need to be aware and be careful about them.

• Straining and difficulty while passing stool
• History of long standing constipation
• Pain and irritation during a bowel movement
• Painless bleeding of fresh red blood in the initial stages
• Prolapsed hemorrhoids may lead to pain and bleeding together
• Itching around the anus
• Small lumps may form around the anal sphincter
• In long standing cases, the chronic bleeding can lead to anemia
• Fecal incontinence

Hemorrhoids and Pregnancy

Pregnancy and hemorrhoids are inter-connected and a common symptom experienced by many pregnant women during their pregnancy. They are seen more in the third trimester when the baby is getting bigger. Many women have them for the first time in their pregnancy. But if you already had them before, they are likely to flare up during pregnancy.

The most common reason why these changes occur during pregnancy is the pressure of the growing fetus on the inferior vena cava which is one of the largest vein of the body. Due to the pressure, the venous return slows down and the blood collects in the vein and swells it. This is also the reason why varicose veins are commonly seen during pregnancy. During pregnancy, the hormone progesterone relaxes the smooth muscles causing the veins to relax and swell even more. Constipation is common during pregnancy and it further adds to the mechanical pressure leading to hemorrhoids.

Diagnosis and Treatment of Hemorrhoids

The patient history and the symptom of painless bleeding per rectum raises the suspicion of haemorrhoid. The diagnosis is confirmed by digital rectal examination where the doctor wears a glove and applies a lubricant on the finger and inserts it into the rectal opening to check for swollen internal veins.

In some cases, sigmoidoscopy may be required. This is a procedure where a tube is inserted into the rectum and it is attached to a fiber optic camera which helps in visualization of the internal piles and the condition of the colon internally. This method is also useful in diagnosing growths, tumors etc arising from the rectum.

The treatment is mainly pain relief medications and fiber supplements to reduce the constipation which will in turn reduce the pain and the bleeding.

In severe cases, hemorrhoid surgery is also suggested to remove the piles. Other treatments available for hemorrhoid relief are schlerotherapy and band ligation.

Prevention of Hemorrhoids

1. Have a high fiber diet and lots of water. Soft stool helps in relieving the pain and also controls the bleeding. Wheat bran, oatmeal, brown rice and green vegetables are good sources of fiber. You may also use psyllium husk which helps to form stool bulk and softens it.
2. Avoid putting off the urge to pass stool. Do not strain hard while passing stool as it increases the pressure within the rectum.
3. Use warm sitz bath every day. Sit in a tub of warm water and soak the anus for 10-15 minutes to get effective pain relief.
4. Exercise regularly. Walking on a daily basis can help reduce constipation. During pregnancy, regular kegel exercises help to strengthen the anal muscles.

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Back pain is a very commonly encountered complaint. It is the general term used for all the pains in the back region. It includes pain in the back, neck pain, shoulders, upper and lower back. Depending on the distribution of the pain, the cause can be identified. The nature of the pain could be dull aching to a sharp shooting pain extending to the legs depending on the level of affection. It could arise from the back muscles, vertebral column, spinal cord nerves or inflammation of the spine.

Causes of Back pain

• Wrong posture of the body.
• Spondylosis
• Spinal stenosis – It is the narrowing of the spinal canal
• Arthritis
• Osteoporosis
• Sciatica
• Disc prolapse or rupture of disc
• Scoliosis- Abnormal curvature of the spine
• Strain-Lifting very heavy weights or overstretching
• Cauda Equina syndrome – Cauda equina is the name given to the bundle of nerve roots arising from the end of the spinal cord. Patients with this syndrome experience low back pain and numbness in the buttocks and upper thigh.
• Tumors located near the spine.
• Secondaries from a metastatic tumor.
• Using a bad mattress which leads to abnormal curvature of the spine.

Signs and Symptoms of Back Pain

The main symptom is pain anywhere in the back. It can extend upwards towards the neck or below to the thighs and legs. The common symptoms are:

1. Pain in the lower or upper back
2. History of injury or trauma to the back.
3. Numbness and tingling
4. Pain extending to the legs
5. Stiffness and difficulty in changing the position
6. Associated symptoms may be urinary or fecal incontinence.
7. Difficulty in bending or changing the position
8. Change in the posture due to joint pain.

Back Pain and Pregnancy

Back pain is a very common complaint of all pregnant ladies. The most common reason is the change in the hormones in the body during pregnancy. The hormone relaxin causes loosening up of all the joints of the body. This gives rise to joint pains and muscle aches while changing the position. The growing fetus also puts pressure on the spine. As the baby grows, the abdomen gets bigger and your center of gravity changes. The posture and gait changes and results in back pain. The pain goes on increasing as the pregnancy advances. The increasing body weight also contributes to the existing problem.

The commonest pain is the lower back pain and stiffness. Another common complaint during pregnancy is sciatica. The pressure of the uterus on the sciatic nerve gives rise to pain which begins in the lower back and extends throughout the back of the leg till the feet. It is also associated with numbness and tingling in the soles.

Tips to Relieve Back Pain

1. When your back aches and you feel like lying down, it is hard to believe that the best way to relieve the pain is to follow the simple exercise for back pain. During pregnancy the best back exercises are walking and swimming. Muscle strengthening and stretching exercises should be done daily under the guidance of a trained physiotherapist to avoid over straining.
2. Give a lot of importance to your body posture. When sitting or standing keep your back straight. If you slump the shoulders due to the growing abdomen, it puts pressure on the spine and worsens the back pain. Avoid standing for long hours and when sitting, keep your legs elevated using a small stool.
3. When you need to bend, always do so by bending your knees. If you bend with your legs straight, then the pressure goes on the back. You are advised not to carry weights at this stage, but if you must then make sure the weight is not too much and is equally distributed in both the hands
4. The best mattress for back pain is a simple hard mattress. It helps in maintaining the spinal curvature and also minimizes the back pain as compared to a soft sink in mattress.
5. When getting up from a lying down posture, always do so by supporting your hand. Avoid jerky and sudden change of positions.
6. Hot fomentation is very effective to ease out the back pain and relax those muscles. Hot water bags or electric heating pads are very useful in chronic lower back pain.
7. Try relaxation techniques like yoga and meditation. The postures in yoga help in stretching the back muscles very well.
8. Other helpful things to try are massages, acupuncture and alternative medicine. They cannot cure the pain if it is due to a structural problem but can definitely relieve the pain symptomatically.

The treatment is generally symptomatic and aimed at treating the cause. You can also take help of a chiropractic expert for the optional treatments. Surgical options like herniated disc therapy and minimally invasive spine surgery may be required in severe cases.

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Constipation is commonly understood as difficult or less frequent bowel movements as compared to normal. But the actual definition of constipation is bowel movements with a frequency of less than three times a week associated with hard and difficult stools. So, many people having only difficult stools are not diagnosed as cases of constipation. It is merely an altered bowel habit.

Causes of Constipation

Constipation causes are directly linked to your diet in most of the cases. However there are some medical conditions that cause constipation. The commonest causes are:

• Eating disorders
• Consuming food lacking in dietary fiber
• Over use of antacids containing aluminium
• Sedentary life style
• Overuse of laxatives
• Pregnancy
• Irritable bowel syndrome
• Avoiding the natural urge to have a bowel movement due to fear of pain. In patients with fissure in colon there is a sharp, pricking pain when passing stool.
• Medications like strong pain killers, anti depressants and iron supplements
• Stress
• Junk food which is low in fiber can cause toddler constipation
• Hypothryroidism
• Newborn constipation

Symptoms of Constipation

Constipation is not a serious disease. But if it becomes chronic and is not checked in time, it can lead to other problems like fissure and hemorrhoids. Fissure is a small cut in the mucous membrane of the anus due to passage of hard stool. It leads to pain and bleeding. Hemorrhoids are swollen rectal veins due to constant straining and pressure in the rectal area. The pain and swelling can cause discomfort and need to be treated with medications.

• Difficulty and straining in passing stool
• Bloating and gas formation due to collection of stool in the intestines
• Unfinished sensation after every stool
• Hard and knotty dark stools
• Irregular bowel movements
• Abdominal pain due to constipation which is mainly due to accumulation of gas
• Hardening of the abdomen in cases of severe constipation
• Loss of appetite and vomiting may occur in some cases

Constipation and Pregnancy

Constipation is a very common problem during pregnancy. Half of all the pregnant women are affected by it. During pregnancy, the hormone progesterone causes relaxation of the smooth muscles of the gut due to which the food tends to move very slowly. This leads to excessive gas formation and constipation. The growing uterus puts pressure on the rectum and leads to some amount of mechanical obstruction. The iron supplementation during pregnancy is another contributing factor to the constipation.

Treatment and Prevention of Constipation

Treatment for acute constipation is usually targeted at softening the stool by means of laxatives, stool softeners and suppositories. Increasing dietary intake or taking isopghul husk also help in increasing the bulk of the stool.

The following tips and lifestyle modifications will help to prevent constipation:

• Eating fiber rich food is the best way to relieve constipation fast. Fiber in the diet will absorb water and increase the bulk of the stool and make it soft. Wheat bran or wheat husk can be added to the food to increase its nutritional value.
• Have lots of water. Drinking a glass of warm water first thing in the morning helps to relieve constipation. Prune juice is also proven very effective in reducing constipation. Many people have a habit of taking hot tea in the morning which helps to move the bowels.
• Exercise regularly. Daily walking, swimming, jogging, aerobics will help to keep you fit throughout the pregnancy. Movement and exercise aids the process of digestion and helps relieve constipation.
• If your prenatal vitamins contain high amounts of iron, check with your doctor if you could be given another combination to check the constipation. Eating green vegetables and iron rich foods will also help to keep your iron levels high.
• Never put off or postpone the urge to pass stool. By doing so, the natural mechanism of the body gets altered and you tend to get constipated.
• Use a mild stool softener if the constipation is acute. Before taking laxatives always check with your doctor.
• In case you have hemorrhoids, try warm sitz bath to relieve the pain and discomfort.
• Never strain at stool as it can lead to an abrasion in the anal mucosa leading to a painful fissure.
• Chronic idiopathic constipation could be a part of a psychosomatic disease which most commonly related to stress. Try to avoid stressful situation and follow relaxation techniques like yoga and meditation.

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When a patient has vitamin b12 deficiency, it is most likely linked with pernicious anemia, an autoimmune disease that destroys the parietal cells. These cells are found in the stomach that secretes intrinsic factor, which is vital in digestion. This kind of anemia cannot be cured but it can be treated and lifespan is prolonged especially if the problem is not treated right away.

Vitamin B12 Deficiency Causes

There are many causes of vitamin B12 deficiency. One of the most common causes is the diet. A vegan diet is at risk for vitamin B12 deficiency. This is because vitamin B12 is mostly from animal products like eggs, meat, and milk. Vegan diets don’t take these types of foods. Additionally, vegan people don’t take fortified foods.

Another cause of this problem is with bowel problem. This happens in post operative surgery for bowel resection. Vitamin B12 cannot be absorbed well into the bloodstream especially in cases of short bowel syndrome. This is a condition wherein half or more than half of the small intestine is removed because of a problem or certain condition.
Aside from nausea, vomiting, a generalized malabsorption or maldigestion can happen.

Chron’s disease can also be a cause for vitamin B12 deficiency. Another cause is the intestinal infection like fish tapeworm.

Endocrine problems like diabetes and taking in metformin can hinder in the absoption of vitamin B12. Other problems like chronic alcoholism, nitrous oxide abuse and even impaired genes can cause vitamin B12 deficiency.

Schilling test is the most reliable and widely used in diagnosing vitamin B12 deficiency. There are 4 stages in diagnosing the problem the first stage wherein the patient is given a radiolabed vitamin B12 to drink and eat. An intramuscular Vitamin B12 is also given. The purpose of this problem is to saturate the B12 receptors in the liver. Also, a urine specimen is taken in the first 24 hours. In the next stage, a second urine specimen is taken results will be shown that
there is a low or lacking intrinsic factor. The third and fourth stage includes identification of bacterial growth that is why taking antibiotics is necessary and pancreatic enzymes are also checked.

Vitamin B12 Deficiency Symptoms

According to medical professionals, the symptoms can vary among individuals who have vitamin b12 deficiency. Also, it depends on the cause of the problem. Vitamin B12 deficiency symptoms include:

• fatigue
• shortness of breath
• dizziness
• headache
• chest pains
• some palpitations
• cold hands and feet
• anemia because of the decrease production of red blood cells

Since pernicious anemia is linked with vitamin B12 deficiency, it also affects the gastrointestinal system. Patients may exhibit signs and symptoms such as:

• Hepatomegaly or enlarged liver can be seen when palpated in the right
• upper quadrant of the abdominal area.
• nausea and/vomiting
• heartburn
• abdominal bloating
• constipation
• frequent passing of gas
• Loss of appetite and eventually weight loss.

Vitamin B12 is also responsible for neurologic functions like sense of balance, walking, thinking and many others. Vitamin B12 deficiency can cause problems like:

• difficulty walking
• confusion
• depression
• memory loss
• tingling  sensation of the hands and feet
• numbness
• Memory loss may also be noticed which can lead to dementia.

Apart from these, there are also other signs and symptoms which include:

• Pale lips
• Brittle nails
• Paresthesia
• Jaundice
• Ataxia
• Lightheadedness
• Swollen red tongue sometimes it is itchy
• Sore mouth
• Disturbed sleep or abnormal sleeping pattern
• Sores on the mouth
• Rapid and/or irregular heartbeat
• Shortness of breath after exercise
• Enlarged spleen

Vitamin B12 Deficiency Symptoms in Children

There are 11 conditions wherein vitamin B12 deficiency is experienced by a child. This includes juvenile pernicious anemia, Chron’s Disease, intestinal malabsorption of vitamin B12, dietary problems, H. pylori infection, fish tapeworm problems, surgical resection of terminal ileum and many others. Treatment for this problem depends on what the doctors advise because they also consider the severity of the problem.

Vitamin B12 Deficiency Symptoms in Adults

If an adult experiences the signs and symptoms of vitamin B12 deficiency, they feel the necessary symptoms like pale lips, jaundice skin, lightheadedness, body fatigue, significantly low red blood cells difficulty concentrating, and many others.

Vitamin B12 Deficiency Symptoms of Women

In women, especially the pregnant ones, it is important take in the necessary vitamins, regular checkup, eating the right foods and exercise. One of the most important vitamins a pregnant woman should take is Vitamin B12. This vitamin is necessary and works hand in hand with folic acid to help in the production of red blood cells. Aside from that, it is necessary in development in the fetal brain and its nervous system. As such, they should consume about 2.6 mcg or about 104 IU of vitamin B12 per day.  In breastfeeding mothers a suggested 2.8 mcg of vitamin B12.

Vitamin B12 can be found in the following food selection: red meat, poultry, eggs and dairy products, shellfish. For those in vegan diet, they can still have an intake of vitamin B12. They just have to select vitamin B12 fortified tofu and even soymilk.

A research was found out that a lack of vitamin B12 and folate intake can lead to neural tube defects to infants about 50 to 70%. This was further strengthened by a study done to about 1,200 Irish women wherein they were divided into 3 groups wherein these women have hit the neural tube defect.

Severe Vitamin b12 Deficiency Symptoms

For those patients with severe Vitamin B12 deficiency symptoms, they exhibit worst problems especially in the neurologic area. They can have impaired perception of deep touch, pressure vibration, persistent paresthesia, ataxia which is the dorsal cord type, decrease abolishment of deep tendon reflexes, babinski reflex, and sever paresis. Sometimes, this is problem can cause irreversible damage to the body.

The treatment of Vitamin B12 deficiency includes injection of hydroxocobalamin. This is a form of vitamin B12 wherein it is injected every 2 to 4 days into the muscle. This is the traditional used of giving vitamin B12. For patients who are afraid of injections, they have an option to take oral pills that has Vitamin B12. This can be in form of sublingual pill where it is placed at the back of the tongue. It can also be in form of liquid or strip, or intranasal spray.

Vitamin B12 is essential in diets and these can be found in meat products, poultry, eggs and dairy products. A recommended daily allowance or RDA is about 97% to 98% in taking all the necessary nutrients for the body. There are different recommended dietary allowances of Vitamin B12 that can be taken by different age groups.

For children in 0-6 months, both male and female is expected to take about 0.4 mcg. For children from 7 months to a year, both male and female needs to take about 0.5 mcg; the same amount of 0.9 mcg should be taken by children from 1-3 years old; 1.2 mcg should be taken by both sexes in years 4-8; 1.8 mcg of Vitamin B12 should be taken by children from 9-13 years old. Lastly, from 14 years old and above, both men and women should take 2.4 mcg, 2.6 mcg  for pregnant women and 2.8 mcg for those lactating.

References:

http://en.wikipedia.org/wiki/Schilling_test

http://ods.od.nih.gov/factsheets/vitaminb12/

http://women.emedtv.com/vitamin-b12/vitamin-b12-and-pregnancy-p2.html

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Food poisoning may appear due to intake of contaminated food in solid or liquid form. This is a common illness all over the world and not specific to particular region or part of the world. Usually, this is mild in its nature. But may cause serious illness.

Depends upon the food poison’s influence on the gastrointestinal tract it is presented with abdominal discomfort, fever, chills, nausea, voimiting, diarrhea, watery stool with blood and mucus. Consequences may be very mild or even fatal. This may affect individuals or group who take the contaminated food. Normally, the symptoms appear immediately after taking the contaminated food and the symptoms take its course up to 48 hours.

About 250 different kinds of diseases are identified but all are not common cause of the diseases. Some most common causes of virus and bacteria are discussed here below.

It is estimated by centre for disease control and prevention that 76 millions of people are affected by food poison, 3,25,000 are admitted to hospital and about 5000 deaths are occurring in America per year and it is well established that diarrheal death are increasing in number world wide.

Viruses are the most common cause of food poison. The public places like schools, hotels and the cities with thick population are places where this disease spread fastly.

Noroviruses are forming a group of virus and they cause mild illness. This illness is accompanying nausea, vomiting, headache and abdominal pain. Fever is also a prominent symptom with diarrhea. These symptoms generally disappear within two to three days. Food poisoning of this virus occurs through contaminated fish, water and vegetables. This is transmitted easily from human to human.

Rotavirus is one of the viruses that cause food poison in the form of diarrhea in children commonly below 5 years of age. This infection is called and named as stomach flu though there is no relation with influenza. There are seven types of viruses in rotavirus namely A B C D E F AND G. Type A is the common one which affects children. But however, the immunity develops whenever it infects and future infection become less severe in its form. The transmission of the disease is fecal-oral route. The toxins are formed when this virus infects human being and this toxin in turn causes gastroenteritis. About 5, 00,000 children die out of this diarrhea every year.

Hepatitis A viruses are causing diarrhea and this is accompanied by fever, fatigue, loss of appetite and with jaundice. The transmission is from human to human by fecal contamination of food.

Bacteria are most common cause of food poison oriented diarrhea and generally they are transmitted from one person to another through fecal contaminated food. These bacterias are causing inflammation of the intestine and it prevents the digestive system to absorb nutrient and the toxins produced by them causing damage to digestive system and cause nausea, vomiting and diarrhea.

The bacterium, salmonella is the common cause of food poison in U.S, several European countries and in Asia. The normal appearing eggs may contain these bacterias when eaten raw or under-cooked and it causes illness.  This infected form of the disease usually has fever, abdominal cramps. Diarrhea begins in 12 to 72 hours after taking this contaminated food. This illness may long last up to 7 days and the patients recover easily and in severe cases hospitalization is necessary. The other route of food poison of this salmonella is poultry, dairy products and sea food.

Camphylobacter is also a most common cause for food poison. This bacterium and its association were identified as a cause of food poisoning in the year 1975. Eating undercooked chicken, meat, cheese, unpasteurized milk is causing this illness. Normally this bacterium lives in the intestines of mammals, and warm blooded birds. Diarrhea is common symptom of this food poison and this lasts for 7 days. The stool examination will reveal the presence of this bacterium.

E.coli is a bacteria that enter in to food like beef and vegetables and the food containing   these bacteria cause food poisoning. Certain type of strains of this E.coli is causing stomach cramp, vomiting, bloody stool and diarrhea. It is transmitted by raw or undercooked meat, juices, contaminated well water and milk.

Shigella is the one of the severe form of diarrhea that can cause even an out-break of he disease. Shigella is a family of bacteria that are able to cause sudden and severe form of diarrhea. This form of diarrhea is also called as bacillary dysentery. It is commonly spread from person to person or through contaminated food. This form of diarrhea always accompanying with a constant feeling for evacuation of stool and the stool will contain blood and mucus.

Pesticides contaminate food materials like fruits and vegetables and consuming this food of fruit causes food poison and such poison may cause mild to severe illness with blurred vision, headache, abdominal cramp, high saliva production and diarrhea. Neurogenic symptoms like tremor in legs and hands may also appear. This is transmitted by eating unwashed fruits or vegetables contaminated with pesticides.

The common treatment for food poisoning is home support of avoiding dehydration with adequate liquid.  After diarrhea is arrested the bland diet such as rice, bread and milk to be taken. In severe cases with nausea, vomiting and fever the patient should be treated properly in the hospital.

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Food poisoning is one of the very common illnesses. It is mild for most people but sometimes become severe and even deadly for some people.

Therefore it is important to be aware of the causes of food poisoning to maintain a healthy and a secure life. The important cause of food poisoning could be the consumption of contaminated food or water.

As all the food items contain small amount of bacteria, improper handling and storage and even improper cooking can lead to the multiplication of bacteria in large number. This will cause food poisoning very easily.

Moreover if the food items for which the expiration date has crossed are consumed then there are chances for food poisoning to occur. Eating foods in hotels, parties are also subjected to food poisoning as these food items are not properly washed and cooked.

The causes of food poisoning can be classified into 2 categories:

• Infectious agents

These include viruses, bacteria and parasites.

• Toxic agents

Poisonous mushrooms, pesticides.

Contamination of food can occur anytime from when the food is obtained and till it is consumed.  It is likely that contamination can occur during the stages of growing, harvesting, processing, storing and preparation. Also in some cases bacteria, viruses and parasites are transferred to food from other sources making these organisms the most common causes of food poisoning.  Sometimes the poison or toxin is naturally part of the food.

Bacteria are the most common cause of food poisoning since they are capable of surviving even in raw food. Raw meat and poultry gets contaminated during slaughter whereas the sea foods get contaminated when they are harvested and processed. The sources of contamination vary from food to food. However the food items are contaminated from the early growing stage.

Leftover food items enhance the multiplication of bacteria very quickly. The growth of bacteria is un detected in most cases because neither the texture nor the color of the food is changed. Though freezing of food slows or stops the growth of bacteria it does not help in complete destruction of bacteria. When the food is thawed, the bacteria are reactivated. By heating the refrigerated food, bacteria can be destroyed.

To be precise, the common causes of food poisoning include the following:

• Bacteria and bacterial toxins

Salmonellae, Campylobacter, Staphylococcus aureus, Bacillus cereus, E.coli, Vibrio cholerae

• Viruses

• Parasites

Giardia (beaver fever), Cryptosporidium

• Mushrooms and toad stools

• Shell fish

• Insecticides

Other causes include wild nuts, flowers and leaves, berries, under ripe tubers, containers made of cadmium, minerals like lead or arsenic from fertilizers and acids and lead from poultry.

Food Poisoning Signs

What could be the symptoms and signs of food poisoning? Almost all forms of food poisoning produce nausea, vomiting, abdominal cramps and diarrhea. Food poisoning due to bacteria results in fever and headache. The symptoms become significant from few hours after the consumption of contaminated food and they may last from a day up to a week depending on the severity. The persons using antacids heavily are subjected to greater risk of getting food poison.

In general the following are the symptoms of food poisoning:

• Nausea, vomiting, diarrhea

• Bloody diarrhea or pus in the stool

• Abdominal pain and cramps

• Fever lasting more than a day

• Dizziness

• Rapid heart rate

• Numbness and tingling in the arms and legs

Symptoms of food poisoning vary from individual to individual depending on the type of contaminant and the amount of consumption. Symptoms can develop rapidly or slowly extending for days and weeks. Food poisoning is generally not serious and the illness runs its course in one or two days. Noninfectious food poisoning affects the central nervous system. Shellfish causes symptoms of excess histamine. Such symptoms include skin rash, face pain, head ache and pain from over stimulation of affected organs like stomach and intestine. The nervous system is also affected by the mushroom poisoning. The symptoms may be shrunken eye pupils, tears, salivation at the mouth, sweating, vertigo, coma and sometimes seizures appear within 2 to 3 hours of eating a poisonous mushroom

Most common complicated result of food poisoning is dehydration. The body loses too much water and electrolytes like sodium and potassium. Food poisoning by ‘Listeria’ bacteria cause problems for unborn babies and E.Coli bacteria cause problems with the kidneys. Other severe complications include arthritis and bleeding problems. The worst case of food poisoning sometimes results in permanent nervous system problems and even death.

To prevent the effects of food poisoning from becoming even more severe it is important that care should be taken to avoid the consumption of food items that had caused food poisoning. Food is contaminated because of poor sanitation and preparation. Food poisoning is entirely preventable. Practicing good sanitation and food handling techniques can help to avoid food poisoning.

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including lymphoma and leukaemia, is called Chemotherapy. It can be used as an isolated treatment for some types of cancers or as a mixture with other cancer treatments like radiotherapy, surgery, hormonal therapy or biological therapies.

The Reasons of Giving Chemotherapy

Chemotherapy is suggested widely to treat some kinds of cancer, especially which can metastasize in other parts, because it invades all the cancerous cells present in the whole body. While other treatments only focus on the cancer cells at specific areas.

• It may be given to shrink a cancer so that in the second step like surgery it can be removed easily.
• Likewise chemotherapy may be used to destroy the remaining cells after a surgery or radiotherapy to improve the results.
• This treatment can prolong life by shrinking the cancer and minimizing its development. This therapy is called Palliative Chemotherapy

The Selection of Chemotherapy Schedule

The nature of chemicals to destroy the cancer depends on many factors such as the type, stage, and structure of cancerous cells. Moreover, the age, general health and tendency to endure the  short term side effects of the suggested chemotherapy.

More than 50 chemotherapy drugs are available among which some are given alone while the others are given in a combination of drugs known as Combination Chemotherapy.

Time to Apply Chemotherapy

There are some conditions or stages when Chemotherapy is used; Primary or Neo-adjuvant Chemotherapy and Post or Adjuvant Chemotherapy, Chemo-radiation or Chemoradiotherapy and Stem Cell Support.

Primary Chemotherapy ( Neo-adjuvant Chemotherapy)

When chemotherapy is used to shrink a large cancer growth or those which are adjacent to the healthy tissues, it is called Primary or Neoadjuvant Chemotherapy. This makes easy the removal of  the cancerous cells during surgery.

Post or Adjuvant Chemotherapy

Chemotherapy can also be given after a surgery or radiotherapy to remove or destroy the remaining invisible cancerous cell in the body. This is called Post or Adjuvant Chemotherapy.

Chemoradiotherapy

In some cases, chemotherapy is given along with radiotherapy, it is called Chemo-radiation or Chemoradiotherapy.

In Metastasized Cancers

When cancer has been spread  to other parts of body, Chemotherapy is used to destroy or shrink the cancerous cells and extend life by controlling the cancer to sprout.

High-dose Chemotherapy and Bone Marrow or Stem Cell  Transplant

In some cases after initial chemotherapy, High-dose Chemotherapy is done to extinct the high risk of cancer to come back. This procedure destroys the bone marrow, so it is replaced by the stem cells gathered from the bone marrow or blood of the patient or a donor. But this treatment is used in specific types of cancer.

The Procedure of Giving Chemotherapy

Chemotherapy is generally given in a series based on the state of the patient and chemistry of the suggested drugs. The series may comprise of daily, weekly or monthly intake of the drugs along with a recovery episode to allow the body to generate new and healthy cells.

Chemotherapy drugs are available in a number of forms. Doctor selects the form or forms of drugs by analyzing the nature and type of cancer. Some kinds of Chemotherapy are as follows:

Oral Chemotherapy

It is given in the form of pills or tablets.

Topical Chemotherapy

It is used to treat localized cancers by applying the drug on the skin.

Intravenous (IV) Chemotherapy

In this type of chemotherapy, a needle infused the drug into a vein, through skin, that let the quick supply of the chemotherapy in the whole body.

Chemotherapy through Injection

An injection is directly injected into the cancerous area or under skin muscle through a needle.

Mechanism of Chemotherapy Drugs

Chemotherapy drugs affected the cancerous cells by traveling in the bloodstream and reaching all over the body. Sometimes the healthy cells are also damaged by chemotherapy but they can be reproduced or recovered when the effects of chemotherapy are disappeared from the body. That’s y the mechanism is consisted of many cycles following a rest period after each cycle. In each session the cancerous cells are destroyed as much as possible while rest period permits the healthy cells to recover. Different drugs destroy cancer cells in various orders. Sometimes a combination of drugs is applied in which each drug is selected due to its different effects.

Side Effects of Chemotherapy

As chemotherapy reaches the whole body so it often causes damages to the healthy cells along with destruction of the cancerous cells. Every chemotherapy drug has different side effects if compared to others. Normally the areas which are more sensitive to chemotherapy include; lining of the mouth, digestive system, hair follicles under, skin and bone marrow. In some patients these side effects can be few while in others they may be a lot. Some last as temporary side effects and some will remain longer.

Temporary Side Effects

They can be appeared in the form of vomiting, dry mouth, nausea, constipation, bleeding, infertility, fatigue, hair loss, mouth sores (stomatitis), diarrhea, liver damage, changes in the food tastes, loss of appetite, heart damage, difficult or painful swallowing (esophagitis), susceptibility to infection, nerve impairment, or lung damage.

The period, to which these short term side effects sustain, is depended on the drug or the combination of drugs taken for how long. Some side effects disappear as the medication is stopped while some are mitigate by medication.

Late Chemotherapy Side Effects

Some side effects reveal long after the chemotherapy ends. These are rarely found. Though, they should be asked by the doctor before undergoing to any type of chemotherapy. Some long-term effects can be turned as blood in the urine (hemorrhagic cystitis), nerve damage, and organ impairment. Sometimes these side effects appear very aggressively as in the form of another cancer such as Hodgkin’s disease, leukemia and non-Hodgkin’s lymphoma and some tumors.

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